Healthcare fraud occurs when a patient or medical professional makes false statements on an insurance claim or falsely bills Medicare, Medicaid, state healthcare services, or a private insurer for financial gain. Depending on the circumstances, a person charged with healthcare fraud could face federal penalties, state penalties, or the suspension or revocation of their professional or medical license. If you or a loved one have questions about the potential consequences of a healthcare fraud conviction in California, here's what you need to know.
Federal Charges vs. State Charges
In Los Angeles, the authorities may accuse a person of federal or state-level insurance fraud. If the matter involves a federal healthcare insurance program like Medicare or Medicaid, you'll most likely face federal charges. If the incident concerns Medi-Cal or the like, you'll likely face state-level penalties.
Several federal statutes criminalize health care fraud. These laws including the:
- Health Care Fraud statute,
- Health Care Fraud Conspiracy statute,
- False Claims Act - which allows for monetary penalties for anyone who knowingly submits a false claim to the government,
- Anti-Kickback Statute - which prohibits individuals from offering a bribe in return for referring a person for a healthcare procedure, and
- Exclusions Provisions allow the Inspector General to exclude individuals from participating in federal healthcare programs for misconduct.
The penalties for a federal conviction can include a prison sentence of up to 10 years and fines of $250,000. If the violation resulted in serious bodily injury, the maximum confinement increase to 20 years. If it resulted in death, there is even a possibility of life in prison.
State Level Penalties
If the state charges you with a fraud claim valued at $950 or less, it's charged as a misdemeanor. The penalties can include a fine of up to $1,000 and a maximum jail term of six months. If the state values the fraud claim for $950 or more, it's considered a wobbler offense. This means the prosecutor has the authority to charge the matter as a misdemeanor or felony offense. A felony healthcare fraud conviction can carry a prison sentence of 2 to 5 years and a fine of up to $50,000 or double the value of the fraud.
Whether it's on the state or federal level, the penalties you face for healthcare fraud can have a lasting impact on your future. You don't want to face these charges alone. The Sigal Law Group has a reputation for successfully defending clients against fraud charges in the Los Angeles area. If you need help, call us at (818) 325-0570 to schedule a free consultation in your matter today.